Hospitals Reinstate Masking Amid Surge in Respiratory Illnesses

COVID Cases Rising Due to New Omicron Subvariants

Several hospitals and healthcare systems across the United States have reinstated indoor masking policies over the past few weeks in response to a concerning rise in COVID-19 cases, as well as flu, RSV, and other respiratory illnesses [1]. States seeing some of the earliest and most significant case increases include Massachusetts, Illinois, Rhode Island, Maryland, and Washington, D.C. [2,3,4].

Experts attribute much of the COVID uptick to the spread of new Omicron subvariants like BQ.1 and BQ.1.1, which now account for over 50% of cases nationwide [5]. These variants appear capable of evading immunity conferred by both vaccination and previous infection. Coupled with increased indoor gatherings and travel around the holidays, conditions have become ripe for a new COVID wave.

Wastewater surveillance data shows that COVID levels in the Boston area are now higher than at any point since last winter’s Omicron surge, lending further evidence that infections are climbing [6]. Hospitalizations have not yet risen to concerning levels, but typically lag case increases by a few weeks.

Hospital Systems Respond to Protect Patients and Staff

In Massachusetts, hospital giant Mass General Brigham announced this week that it would reinstate universal masking policies at all of its facilities beginning January 3rd [7]. The policy requires all staff, patients, and visitors to wear surgical masks regardless of vaccination status while indoors.

MGB cited not just rising COVID cases in making their decision, but also an unusual spike in flu, RSV, and other seasonal illnesses straining hospital capacity statewide [8]. Pediatric hospitalizations for respiratory viruses have hit record levels for this time of year.

Several other major hospital systems in Massachusetts, including UMass Memorial and Baystate Health, have enacted similar policies over the past two weeks [9, 10]. Care New England and Lifespan, the two largest healthcare providers in Rhode Island, also reinstated universal masking last week due to the pressure from respiratory illnesses [11].

Outside of New England, Northwestern Medicine near Chicago also mandated masks again at its hospitals and clinics shortly before the holidays, as Illinois emerges as another COVID hotspot [12].

Hospital leaders are hoping universal masking will help control virus spread and prevent staffing shortages during an already challenging winter respiratory virus season. It also protects vulnerable patients, as COVID and the flu can pose serious risks for those who are immunocompromised, elderly, or have other medical conditions.

Health Officials Urge Caution Amid Variant Spread

With evidence mounting that new Omicron sublineages are fueling a winter COVID resurgence, public health agencies are advising people to exercise caution and utilize prevention strategies like masking and testing.

On December 28th, the Illinois Department of Public Health recommended universal masking and other mitigation measures be implemented in all healthcare facilities located in areas with elevated COVID transmission [13]. The advisory came as Illinois is currently facing its third straight week of rising cases and hospital admissions.

Meanwhile, a coalition of Maryland hospital executives, physicians, and public health experts sent an open letter urging all healthcare providers across the state to reinstate universal indoor masking [14]. They warned the combination of surging flu, RSV, and COVID cases was pushing some pediatric hospitals to capacity.

Federal officials have stopped short of recommending widespread masking mandates, but say local governments need to monitor the data closely and have plans in place to respond if their healthcare infrastructure becomes strained [15].

CDC director Dr. Rochelle Walensky said earlier this month: “The responsible thing for us to do is to make sure that we are prepared and that we ask people to take actions that could keep themselves and their loved safe – like being up to date on your Covid vaccines… making sure you have access to tests… talking to your doctor about whether you’re eligible for treatments like Evusheld or Paxlovid if you get infected, and then continuing to monitor the data.”

What Happens Next?

With the year-end holidays just concluding, experts anticipate COVID cases and hospitalizations will continue rising through most or all of January before peaking. The severity of the wave remains uncertain and will depend heavily on uptake of the new bivalent booster shots.

Barring a dramatic resurgence on par with previous variants like Delta or Omicron, widespread lockdowns appear unlikely at this stage. However, health officials stress that could change quickly if combination of COVID and influenza hospitalizations start overwhelming healthcare systems. Mask mandates and other mitigation measures would likely follow if that worst-case scenario begins to play out.

People can help reduce the strain on hospitals by getting up to date on COVID and flu vaccinations as soon as possible. Other recommendations include avoiding large gatherings if sick or symptomatic, maintaining improved ventilation indoors, and masking in crowded public spaces.

The coming weeks will prove pivotal in determining how much disruption this COVID wave may cause as the nation enters the third year of the pandemic. Regardless of what mitigations may or may not be mandated, individual actions to curb virus transmission remain critical to protecting health infrastructure through the winter. Healthcare leaders will be monitoring the trajectory closely and adjusting policies to keep patients and essential medical staff safe.

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